Breast-Feeding after Breast Cancer

Breast-feeding can be a challenge even under the best of circumstances.

But for breast cancer survivors, it’s a whole different ball game. Our breasts, unlike those of other women who’ve just given birth, have been poked, prodded, biopsied, radiated, and sliced open. If we’ve made it through that ordeal and, safely on the other side, have managed to get pregnant and give birth, it may feel like asking too much to be able to breast-feed as well.

But it’s not. It’s true that many breast cancer survivors are unable to breast-feed after giving birth. If you’ve had a double mastectomy, of course, it’s just not possible; and for other women challenges such as the aftermath of radiation may be insurmountable. No breast cancer survivor should ever feel that she is doing anything less than the best for her baby if she’s unable to breast-feed.

In some cases, however, it is possible for breast cancer survivors to nurse their babies. And as we all know, nursing has a host of benefits for both baby and mother, not least of which is reduction in breast cancer risk for Mom. If it’s physically possible, we should at least have the support and the information to give us a fighting chance to try to nurse our babies! That’s why, when writing my book Having Children after Cancer, I knew it was essential to include a section on breast-feeding with tips from a lactation consultant. I spoke with Pat Shelly, who’s worked with moms who’ve had breast cancer, who helped develop the following:

Plan ahead. Start getting ready to breast-feed while you’re still pregnant. As soon as you see a bit of milk coming from the “good” breast during pregnancy, try to hand-express milk from the other breast and periodically sit down with the pump. “It stimulates growth in areas that have been compromised, and it builds your confidence,” Shelly says.

Seek out support—informed support. My otherwise absolutely wonderful and rather crunchy obstetrician informed me in the hospital that I should only nurse ten minutes “on each side” or I’d become engorged. (She kept forgetting I only had one “side.”) Luckily, I’d read enough to know that wasn’t true and kept on nursing my baby as long as he wanted. Use the kellymom.com directory at www.kellymom.com/lcdirectory/index.html to find a lactation consultant near you; you can also ask your obstetrician, pediatrician, and friends who’ve breast-fed. Call a few lactation consultants before you give birth to see whom you’re most comfortable with, and ask if they’ve ever worked with breast cancer survivors before. You can also attend lactation classes at the hospital where you’ll deliver. The support you get should also come from your family and friends. Talk to your husband and other family members ahead of time about how important breastfeeding is to you, and tell them that you will need their encouragement to keep going, not comments like, “You can always quit.” You know you can quit. You’ll need to hear that you’re doing great.

Plan on intense breast-feeding during the first month or so. Breast-feeding during the first couple of months isn’t easy even for women with two functioning breasts. Set yourself up with lots of support for the early weeks and expect that during that time you’ll basically be a breast with baby attached. Breast-feeding is a demand-and-supply issue: the more you nurse, the more milk you make, especially early on. Don’t give yourself a schedule: nurse your baby as often and for as long as he or she wants. And practice “kangaroo care” between feedings—that means lots of skin-to-skin contact. “Each minute that goes by with the baby close to your chest, your body is seeping with oxytocin hormones that can help milk come in faster,” Shelly says.

Care for your overworked breast. Don’t wait until after your nipple is sore, peeling, or cracked to apply nipple cream like Lansinoh—do it daily from the get-go. (Don’t, however, follow the old wives’ tale that advises rubbing the nipple with a rough washcloth to “toughen it up.” That will make it even more tender when you start nursing.) Actually, I ended up replacing my lanolin cream with a cheaper alternative—breast milk. I had read about breast milk’s natural healing properties, so I tried rubbing a little expressed milk on the nipple a couple of times a day and letting it air-dry before putting my top back on—and I never once had a cracked or bleeding nipple. You can even start doing this before the baby is born, late in pregnancy when your colostrum starts to come in.

Buy different equipment. The standard nursing bras don’t work too well for us one-boobed nursers. One cup is full to overflowing and the other is half-empty and drooping. To address this problem, either get fitted for a “cutlet”—a small bra implant—at a cancer center or lingerie shop, or skip the nursing bra entirely and go with a nursing tank instead. The tank has a more uniform effect, so the smaller side isn’t as floppy as with a half-empty bra cup. It’s still noticeably smaller, though, so if you have an issue with looking a little lopsided, go with the cutlet. I went with the tanks, which are oh-so-comfortable and make nursing in public supereasy. But I still wound up blushing a bit, like when a clerk at Target told me she knew my son was breast-fed because, “You look really engorged on that side!” Once I picked my chin up off the floor, I gently informed her about the whole cancer thing.

Handle supplementation carefully. If you have to supplement early on due to low supply, do it in a way that doesn’t encourage your baby to prefer a bottle. “Some babies can easily be ‘ambidextrous,’ whereas others can have a strong bottle preference,” says Shelly. “Hold the bottle horizontally, not vertically, so the baby has to pull at the nipple rather than having milk drip into [his or her] mouth. That makes [the baby] less likely to prefer the bottle simply because getting milk from it is easier.” While you’re feeding your baby a pumped bottle, be sure to give lots of skin-on-skin time so that the baby learns to associate skin-to-skin contact (as with nursing) with a full tummy. And don’t forget to pump right around the time of any bottle feedings to encourage milk supply.

Once you’ve successfully made the journey to parenthood—whatever your path—it doesn’t mean that cancer stops being relevant. Those of us who’ve faced cancer have a much more intimate relationship with our mortality, at a much younger age, than people who haven’t. And that can affect how we think about parenting and our plans, hopes, and fears for our children. As we cuddle our kids, the “what ifs” can be hard to ignore. In the next chapter, we’ll talk about how to put cancer in perspective when you’re a parent.